Incidence and
Prevalence
Overactive bladder affects men and women equally.
Causes
A malfunctioning detrusor muscle may cause overactive
bladder. Identifiable underlying causes include the following:
-Bladder stones
-Drug side effects
-Neurological disease (e.g., stroke, spinal cord lesions,
Parkinson’s disease)
-Nerve damage caused by abdominal trauma, pelvic trauma,
or surgery
Other conditions can produce symptoms similar to those
experienced with OAB, the most common of which is urinary
tract infection (UTI) in women.
Signs and Symptoms
Three symptoms are associated with an overactive bladder:
Frequency (frequent urination)
Urgency (urgent need to urinate)
Urge incontinence (strong need to urinate followed by leaking or involuntary
and complete voiding)
Management
A physical examination; and one or more diagnostic procedures
help the physician determine an appropriate treatment plan
for overactive bladder. In males, attempts should be made
to exclude a prostate diseases are the present with similar
features.
Medical history
A complete medical history including a voiding diary is obtained. The medical
history includes information about bowel habits, patterns of urination and
leakage (when, how often, how severe), and whether there is pain, discomfort,
or straining when voiding. The patient's history of illnesses, pelvic surgeries,
pregnancies, and medications currently used also supply the physician with
information relevant to making a diagnosis. In the elderly, a mental status
evaluation and assessment of social and environmental factors is sought.
Physical examination
A physical examination with emphasis on the neurological status and examination
of the abdomen, rectum, genitals, and pelvis is conducted. The patient may
present with an ammoniacal odour or stain marks on the pants. The cough stress
test, in which the patient coughs forcefully while the physician observes
the urethra, allows observation of urine loss. The physical examination also
helps identify medical conditions that may be the cause of overactive bladder
e.g. poor reflexes or sensory responses may indicate a neurological disorder.
Investigations
Mid stream urine for microscopy, culture and analysis
may show:
-Bacteriuria-presence of bacteria in urine; indicates
infection
-Pyuria-presence of pus in urine; indicates infection
-Hematuria-blood in urine; may indicate stones, schistosomiasis
disease
Specialized Testing
If overactive bladder persists after diagnosis and treatment, additional testing
may be needed. Urologists perform urodynamic, endoscopic, and imaging tests
to obtain a more extensive evaluation of the lower urinary tract to determine
a new treatment plan.
.
Postvoid residual volume (PRV)
This procedure requires catheterization or pelvic ultrasound. The patient voids
just before the PRV is measured. This initial void should be observed for
hesitancy, straining, or interrupted flow. A PRV less than 50ml indicates
adequate bladder emptying. Repeated measurements of 100 to 200ml or higher
represent inadequate bladder emptying. The clinical setting and the patient's
readiness to void may affect the test result; therefore, repeated measurements
may be necessary.
Urodynamic Tests
Cystometry may be used to measure the anatomic and functional status of the
bladder and urethra. The cystometer is an instrument that measures the pressure
and capacity of the bladder; thus evaluating the function of the detrusor
muscle
Cystoscopy may be performed when urodynamic testing fails to duplicate symptoms,
when the patient experiences new symptoms (e.g., cystitis, pain), or when
urinalysis reveals a disease process (e.g., pyuria). Cystoscopy identifies
the presence of bladder lesions (e.g., cysts) and foreign bodies.
Imaging Tests
IVU and ultrasound may be used to evaluate anatomic conditions associated with
overactive bladder. Imaging of the lower urinary tract before, during, and
after voiding is helpful in examining the anatomy of the urinary bladder
and urethra.
Treatment
Treatment modalities include
Bladder Training with Timed Voiding
This treatment is used for urge and overflow incontinence. The patient keeps
a voiding diary of all episodes of urination and leaking, and the physician
analyzes the chart and identifies the pattern of urination. The patient uses
this timetable to plan when to empty the bladder to avoid accidental leakage.
In bladder training, biofeedback and Kegel exercise help the patient resist
the sensation of urgency, postpone urination, and urinate according to the
timetable.
Medication
Drugs such as oxybutynin chloride and tolterodine are taken orally, once a
day, for overactive bladder. They can improve symptoms within 2 weeks, however,
cannot be used in all prospective patients due to their anticholinergic side-effect
Oxybutynin Transdermal System
The oxybutynin transdermal system is a thin, flexible, clear patch that is
applied to the skin of the abdomen or hip, twice weekly. This treatment delivers
oxybutynin continuously into the bloodstream and relieves symptoms for up
to 4 days thus allowing twice a week dosing.
Sacral Nerve Stimulation
It is a reversible treatment for people with urge incontinence caused by overactive
bladder who have failed to respond to behavioural treatments or medication
in which an implanted neurostimulation system sends mild electrical pulses
to the sacral nerve, the nerve near the tailbone that influences bladder
control muscles. Stimulation of this nerve may relieve the symptoms related
to urge incontinence.
Surgery
Surgical augmentation of the bladder is reserved for people who do not benefit
from bladder retraining or medication.
Those who cannot take medication due to medical conditions
or intolerance may find incontinence management devices
helpful.
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